A BILL to amend and reenact §9-2-9 of the Code of West Virginia,
1931, as amended, relating to the state’s Medicaid program;
requiring public notice of state plan amendments,
reimbursement changes, demonstration projects and waiver
applications; providing for a public comment period and
response to all public comments; and requiring approval by the
Legislative Oversight Commission on Health and Human Resource
Accountability prior to submission to the federal government
for approval.

Be it enacted by the Legislature of West Virginia:

That §9-2-9 of the Code of West Virginia, 1931, as amended, be
amended and reenacted to read as follows:

(a) The Secretary of the Department of Health and Human
Resources shall:

(1) Develop a managed care system to monitor the services
provided by the Medicaid program to individual clients;

(2) Develop an independent referral service including the
review of individual cases for abuses of the program; and

(3) Develop a schedule for implementation of the managed care
and independent referral system. The managed care system shall
focus on, but not be limited to, the behavioral health and mental
health services.

(b) In addition thereto, and In accordance with applicable
federal Medicaid laws, the secretary shall prepare recommendations,
to be submitted to the Joint Committee on Government and Finance.
In developing recommendations the secretary shall consider as
options the following:

(1) Review of Medicaid services which are optional under
federal Medicaid law and identification of services to be retained,
reduced or eliminated;

(2) The elimination, reduction or phase-out of: (I)

(A) Services which are not generally available to West
Virginia citizens not covered under the state's Medicaid program;
or (ii)

(B) Services which are not generally covered under group
policies of insurance made available to employees of employers
within the state;

(3) The elimination or reduction of services or reduction of
provider reimbursement rates for identified services of marginal
utility;

(4) Higher reimbursement rates for primary and preventive
care;

(5) Changes in fee structure which may include a system of
prospective payments and may include establishment of global fees
for identified services or diagnoses including maternity care;

(6) Utilization caps for certain health care procedures;

(7) Restriction of coverage for cosmetic procedures;

(8) Identification of excessive use of certain health care
procedures by individuals and a policy to restrict excessive use;

(9) Identification of services which reduce the need for more
costly options for necessary care and retention or expansion of
those programs;

(10) Identification of services for which preauthorization is
a requirement for Medicaid reimbursement;

(11) Recommendations relating to the development of a
demonstration project on long-term care which demonstration project
may be limited to patients with alzheimer's disease;

(12) A policy concerning the department's procedures for
compliance, monitoring and inspection; and

(d) The secretary shall report to the Joint Committee on
Government and Finance on the development and implementation of
Medicaid programs that provide incentives to working persons. The
secretary shall consider:

(4) A system to improve monitoring of collections,
expenditures, service delivery and utilization.

(e) The secretary shall report quarterly to the Joint
Committee on Government and Finance regarding provider and facility
compliance with federal and state Medicaid laws including, but not
limited to, the following:

(1)The Number of inspections conducted during the previous
quarter;

(2)A description of programs, services and facilities
reviewed;

(3) Findings; and

(4) Recommendations for corrections.

(f) The secretary shall, upon federal certification of the
claims management system, ensure that the claims management system
processing Medicaid claims provides:

(3) Specific utilization data by provider, member eligibility
groups and service no later than October 1, 2006.

(g) The secretary shall provide public notice of proposed
amendments to the state plan for Medicaid, proposed changes to the
reimbursement schedule for Medicaid, demonstration projects
permitted by federal law and any waiver applications. The notice
shall be filed with the Secretary of State for publication in the
State Register. The notice shall include:

(4) A date, time and place for the receipt of public comment
in the form of written statements and relevant documents.

(h) The secretary shall consider and publicly respond to all
comments received pursuant to subsection (g) of this section.

(i) All proposed amendments, demonstration projects,
reimbursement schedule changes or waiver applications, along with
public comments and responses to the public comments, shall be
reviewed and, where applicable, approved by the Legislative
Oversight Commission on Health and Human Resource Accountability.

(j) If circumstances require expedited approval, the secretary
may file the information required in subsection (g) of this section
with the co-chairs and the senior minority member of each house on
the Legislative Oversight Commission on Health and Human Resource
Accountability for an expedited process.

(k) Upon approval by the Legislative Oversight Commission on
Health and Human Resource Accountability, the secretary may file
the proposed plans and changes with the federal government for
final approval.

NOTE: The purpose of this bill is to require public notice of
amendments to the state’s Medicaid program, waiver applications,
changes to reimbursement and demonstration projects; to provide for
a public comment period and response; and, to require approval by
the Legislative Oversight Commission on Health and Human Resource
Accountability prior to submission for federal approval.

Strike-throughs indicate language that would be stricken from
the present law and underscoring indicates new language that would
be added.